Journal of Social Sciences (coes&rj-jss) issn (E): 2305-9249 issn (P): 2305-9494 Publisher: Centre of Excellence for Scientific & Research Journalism Online Publication Date: 1st July AprilJuly 2013 2014 Online Issue: Volume 23, Number 323



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Journal of Social Sciences (COES&RJ-JSS)

ISSN (E): 2305-9249 ISSN (P): 2305-9494

Publisher: Centre of Excellence for Scientific & Research Journalism

Online Publication Date: 1st July AprilJuly 2013 2014

Online Issue: Volume 23, Number 323, July AprilJul 20132014

http://www.centreofexcellence.net/J/JSS/JSS Mainpage.htmhttp://centreofexcellence.net/J/JSS/Vol2/No2/JSSJuly2013.htm


Time as a determinant for National Health Insurance Scheme Subscriber Health Care Utilization.
Mavis Aggrey, Frank Frimpong Opuni, Bernard Cudjoe Nkum

Introduction:

The Time patients spent in the utilization of health care services could be a fundamental factor that determines clients’ subscription to the National Health Insurance Scheme in Ghana. Thus, Health utilization would partly depend on clients’ perception about the number of minutes spent in accessing health care other than non-card bearers


Methods:

The study adopted a non-experimental design in eliciting information from involving health clients (18 to 70 years) who accessed health services in the Bantama sub-metro in the Kumasi metropolis. The sample size included 400 clients from ten health facilities. The researcher used interviews and semi-structured questionnaires to collect data and used SPSS version 20 for processing whiles descriptive and inferential statistics was supported with STATA 11.


Results:

Majority of subscribers assessed healthcare with their National Health Insurance (NHI) cards. Respondents 216 (54%) indicated there were delays in seeing a doctor, getting laboratories done, and accessing health care as a whole. Seventy-four percent (74%) of the entire population attributed both NHIS and cash and carry systems as the payment methods associated with delays in health facilities.


Conclusion:

Clients’ perceptions about how long they spend in accessing health care influences their utilization of healthcare under the National Health Insurance Scheme. Increased enrolment in the scheme should be supported with provision of efficient services that prevent delays in health care in order to enhance clients’ satisfaction.


Key words:

Ghana, Health Insurance, Perception, Satisfaction, Health, Utilization, Time, Care, Client
Citation:

Mavis, Aggrey; Frimpong, Frank Opuni; Nkum, Bernard Codjoe ; Christopher, Appiah Seth; Time as a determinant for National Health Insurance Scheme subscriber Health care utilization.; (July, 2014); Journal of Social Sciences (COES&RJ-JSS), Vol.3, No.3, pp: 399-4077.



Introduction

Health is very vital in human existence. Good health is undoubtedly a vehicle of development1. Several research works attest to the direct link that exists between good health and overall development. This has raised the concern for countries to consider the health needs of their citizenry as a major priority.


Ghana is not an exception of such countries which have considered health as an integral component in ensuring national progress. The National Health Insurance Scheme which is a form of social protection was put in place in 2003 with the central focus of helping people especially the poor to leap-out of poor health due to the expensiveness of access to health in the country2. It was launched to replace the former “cash and carry system” which forced the people to pay money in cash when they needed to see a doctor or to go to a hospital. The Scheme started with a large influx of people registering for it with the aim of accessing health at relatively very low cost. Contrary to the start of the scheme where people registered in large numbers, majority of people are constantly falling-out and those who were prepared to register have now refused to join the scheme. Several systemic barriers have been cited to impinge upon the smooth operation of the scheme.3, 4,5,6,7,8,16. One key factor that seems to play an influential role with regards to the subscription of the scheme and subsequent health care utilization but received little attention is Time.
Review of Related Literature

Perception of waiting time affects service utilization be it positively or negatively9. Alatinga and Williams 10 in their study reported that persons uninsured receive medical attention or treatment promptly at the health facilities as compared to the insured. Bassili et al 11 in a study in Egypt identified that insured clients had a significantly higher frequency of physical examination, laboratory investigations and diabetes education compared to their uninsured12. The perception related to the disparity that existed between the insured and uninsured in NHIS was not limited only to quality of medication but also time spent at the facility10,11,12.


Alatinga and William10 reports that Uninsured clients wait for less than 30 minutes to be attended to by a health provider whereas few of the insured wait for the same time to see a health provider the study revealed. These findings indicated that, the uninsured are given quick services than the insured. However, D. Adei, V.; Osei K. and S.K. Diko presents no disparity in treatment for insured and uninsured as about 82.2% of household heads confirmed their satisfaction with the behaviour of health personnel with only 11.7% expressing disapproval in terms attending to their needs13.
The WHO claims and requires a responsive health system to treat all categories of patients equally without discrimination (WHO 2000). Turkson (2009)14 concludes that majority of patients (83.4%) found the waiting time at health facilities in Komenda-Edina-Eguafo-Abrem (KEEA) District in the Central Region of Ghana to be reasonable. Bruce E, Narh-Bana S, Agyepong posits in their findings in 2008 reports a contrasting finding on the study of the Dangme West indicating shorter waiting times for uninsured compared to their counterparts who were carrying health insurance cards15. In Burkina Faso16 insured respondents complained of long waiting times when they access health care services. The reasons for the delay have found expressions in the processes that the insured goes through in terms of documentation. Given their (insured) high attendance rates, waiting times gets longer. This study examines as to whether time is really a determinant for National Health Insurance Subscriber Health Care Utilization in Ghana.
Methods

Data and Sample

The study adopted the cross sectional design as well as the mixed sampling technique. The study was conducted amongst health clients (400) who accessed health care services in ten health facilities in the Bantama sub-metro in the Kumasi metropolis. A mixed sampling technique was used. The main tools or instruments used for data collection were questionnaire and interview guide.


Sample Characteristics

The sample considered in the study is made up of clients who are 18-70 years. Those below 18 and above 70 were excluded because they fall within the exemption category of the NHIS. The sample size considered was influenced by the average monthly number (10%) of patients seen at each selected facilities. At the facility, a systematic random sampling was used in selecting the clients from the list of clients. The Confidence Interval was taken as ±1.96 at 95% Confidence Level.


Measures

The dependent variable in the study is “Health care utilization” and the independent variable is “Time”.


Statistical Analysis

The study results were analyzed in both qualitative and quantitative terms. Data was collected from both primary and secondary sources. Tables, graphs and charts were used to ascribe quantitative value to qualitative data to make them amenable to statistical analysis. The responses and findings were converted to percentage scores to serve as units of measurement of results and findings of the study.


The greater the percentage of responses and findings the more it was accepted as the opinion pool of the respondents (clients).
Results:

The results of the study are explained below with their respective tables and figures indicated at the section dubbed “list of tables and figures”.


Time spent in accessing healthcare

Table 1.1 presents the summary of delays in accessing health utilization under NHIS. About 4.1% of the respondents said they rarely visit health facility after the introduction of the scheme while about 35% of them indicated that, they visited health facilities whenever they are sick. Majority, 52.1% of the respondents reported that they spent from between 30 minutes and an hour to get their cards after entering the health facility whereas about 33.3% also indicated that they spend less than 30 minutes to be able to get their OPD cards. Again, about 29.4% of the respondents indicated that they spend more than two hours before seeing a physician after acquiring their cards whiles 38.2% of the respondents indicated they spend from between 30 minutes to an hour.


Majority 62.1% of the respondents indicated that, there are delays to see a physician once you hold the NHIS card. Also, 31.8% of the respondents indicated that, they spend from between an hour to two before they are handed their prescribes drugs from the dispensary whiles almost 30% of the respondents indicated they spend more than 2 hours to get their drugs. When quizzed about the time spent in a hospital when one has an insurance card, about 40% of the respondents indicated that they spend more than 3 hours to access healthcare once they have their cards.
Sections in health facility where delays occurred

As shown in Figure 1.1, 48% of the respondents attributed long hours spent in the hospital to the time they spend at the laboratory for their laboratory results. Almost 28% of the respondents also attributed the claim to time wastage at the consulting room during patient examination. Only 9% of the respondents cited the record departments for some of the causes of delay at the health facility.


Payment systems associated with delays at the health facility

Figure 1.2 shows the methods of payment systems associated with delays in health facilities. About 5% of the respondents attributed it to NHIS whereas 21% of the respondents also attributed it to cash and carry system. However, 74% of the respondents attributed both NHIS and cash and carry systems as the payment methods associated with delays in health facilities.


Time spent in receiving care under NHIS

Figure 1.3 gives a summary of respondents overall rating of time spent at the health facility. As shown, 40.0% of the respondents opined that they spent too long a time to access health care with their cards. Again, almost 35.1 % of the respondents also indicated that they spent a long time to access health care. Only 4.6%of the respondents indicated that they spend short time in accessing healthcare with their cards.


The in-depth-interview also revealed that the delay in acquiring a card at the hospital could be due to insufficient workers, increased workload, conversation among health staffs and long queues. Delay in seeing a doctor could also be due to insufficient doctors, increased workload of doctors and long queues. Majority of the participants in the in-depth interview disclosed that they do not get their laboratory results easily done. One participant disclosed;
There is always a long queue here and you have to wait long before you are attended to’. There sometimes some people refuse to do the lab here. I think something must be done about it because it is frustrating’.
However, most of the participants opined that the non-insured spend much time at the facility because they have to go through a lot of procedures. Almost all the participants express the likeness for the NHIS with regards to time spent at the health facility. A participant explained;
I prefer the NHIS to the cash and carry because with the NHIS you only need your card and you will be attended to at the health facility and it doesn’t involve many procedures so I spend less time’.
Discussions

Decisions of clients to enroll and remain in the scheme are fundamental for the continued sustenance of the scheme. However, success or failure in addressing perceptions has a cumulative effect (positive or negative) on enrolment (Lee et al. 2010)9 and therefore the need to have a critical look at how clients perceive health provision as well as service provision of scheme. Healthcare provision in limited poor settings is mostly marked by delays and long waiting times due to inadequate staffing and facilities. This study reported various delays in health provision to clients in the Kumasi metropolis.


Majority of respondents in this study reported that there are delays to see a physician once you hold the NHIS card. This indicates that clients perceive that their long waiting times at the facility are because they hold NHIS cards. About 15% of the clients interviewed spent more than an hour in getting their card and about 54% spend over an hour before seeing a doctor or a medical assistant (Table 1.1). The delays were also reported of laboratories and dispensaries with more than 50% of clients’ spending more than an hour in each case and about 30% spending more than two hours in the case of the dispensary. Majority of the clients found the time spent at the facility to be too long. Contrary to these findings, Turkson14 concludes that majority of patients (83.4%) found the waiting time at health facilities in Komenda-Edina-Eguafo-Abrem (KEEA) District reasonable.
In general, about 40% of the respondents indicated that they spend more than 3 hours to access healthcare once they have the card. More than 70% of the clients also stated that there was no difference between the NHIS and the cash and carry system in terms of waiting time. In the bivariate analysis, client’s perception of the speed of service was not significantly different among those who access healthcare with and without the NHIS card. However this study results was inconsistent with the study by Alatinga and Williams10, which reported that persons uninsured receive medical attention or treatment promptly at the health facilities as compared to the insured. Respondents from that study disclosed that the uninsured clients wait for less than 30 minutes to be attended to by a health provider whereas few of the insured wait for the same time to see a health provider. Again, Bruce E, Narh-Bana S, Agyepong 15 reported in the study of the Dangme West that waiting times were shorter for uninsured compared to their counterparts who were carrying health insurance cards and was further reiterated in a study in Burkina Faso where insured respondents complained of long waiting times when they access health care services. This study provides a contrast with the insured clients having less time to wait before being attended to compared to uninsured clients who had to go through several hospital processes. This contrast is due to the improvements in the health insurance customer service in addition to the high acceptance health care providers are giving to NHIS card holders.
Conclusion

The study has brought to the fore and adds to the surging studies about NHIS client satisfaction with health care accessed. The study presents that there are still delays in accessing health care which was attributed to multiple service factors. There is therefore the need for service providers to improve upon the efficiency of heath care delivery under the scheme so as to improve the health status of subscribers in the country.


List of Tables and Figures

This section presents the tables and figures used in the study



List of Tables

Table 1.1: Time spent in accessing health care under NHIS

Variables

Frequency

Percent

How often do you visit health facility after the introduction of the NHIS? (n=392)

  • Whenever I am sick

  • Weekly

  • Once in a month

  • Twice in a month

  • Once in every three months

  • Once a year

  • Rarely

0
137

22

64



97

31

25



16

35.0


5.6

16.3


24.7

7.9


6.4

4.1


Time spent to get card after entering the health facility (n=397)

  • <30 minutes

  • 30mins to 1hr

  • >1hr

132


207

58

33.3

52.1


14.6

Time spent to see Dr, /MA after acquiring your card (n=395)

  • <30 minutes

  • 30mins to 1hr

  • 1hr – 2hrs

  • >2hrs

30

151



98

116

7.6

38.2


24.8

29.4


Are there any delays before you see the Doctor (n=396)

  • Yes

  • No

246


150

62.1


37.9

Time spent to get your prescribed drug from the dispensary (n=258)

  • <30 minutes

  • 30mins to 1hr

  • 1hr – 2hrs

  • >2hrs

47

52



82

77

18.2

20.2


31.8

29.8


Time spent get your laboratories done (n=251)

  • <30 minutes

  • 30mins to 1hr

  • 1hr – 2hrs

  • >2hrs

29

70



111

41

11.6

27.9


44.2

16.3


Averagely how long do you spend on a particular day at the hospital under NHIA? (n=393)

  • < 1hr

  • 1hr – 2hrs

  • 2hrs – 3 hrs

  • >3hrs

34

87



114

158


8.7


22.1

29.0


40.2

How long do you spend in accessing health care from the time you enter till the time you leave the health facility (n=394)

  • < 1hr

  • 1hr – 2hrs

  • 2hrs – 3 hrs

  • 3hrs – 4hrs

  • >4hrs

26

73



75

49

171



6.6


18.5

19.0


12.4

43.4


Source: Field data, 2013
List of Figures

Figure 1.1: Sections in health facility where delays occurred



Source: Field data, 2013

Figure 1.2: Payment systems associated with delays at the health facility



Source: Field data, 2013


Figure 1.3: Time spent in receiving care under NHIS



Source: Field data, 2013
Author Contribution
Appiah S.C.Y Conceived and designed the experiments, analyzed the data, wrote the paper drafted the paper made input on preliminary and final analysis.

References

1. WHO report 2000. Health needs and Development; Evidence, lessons and Recommendations for action as accessed @ url on the 7th February, 2014.

2. National Health Insurance Scheme, www.nhis.gov.gh

3. Buor, D. 2004. Gender And The Utilisation Of Health Services In The Ashanti Region, Ghana. Health Policy, 69, 375-388.

4. De Allegri, M., Kouyaté, B., Becher, H., Gbangou, A., Pokhrel, S., Sanon, M. & Sauerborn, R. 2006b. Understanding Enrolment In Community Health Insurance In Sub-Saharan Africa: A Population-Based Case-Control Study In Rural Burkina Faso. Bulletin Of The World Health Organization, 84, 852-858.

5. Sinha, T., Ranson, M. K., Chatterjee, M., Acharya, A. & Mills, A. J. 2006. Barriers To Accessing Benefits In A Community-Based Insurance Scheme: Lessons Learnt From Sewa Insurance, Gujarat. Health Policy And Planning, 21, 132-142.

6. Kamuzora, P. & Gilson, L. 2007. Factors Influencing Implementation Of The Community Health Fund In Tanzania. Health Policy And Planning, 22, 95-102.

7. Ndiaye, P., Soors, W. & Criel, B. 2007. Editorial: A View From Beneath: Community Health Insurance In Africa. Tropical Medicine & International Health, 12, 157-161

8. Asante, F., & Aikins, M. 2008. Does the NHIS cover the poor? . Accra: Ghana: Danida ⁄

Institute of Statistical Social and Economic Research (ISSER).

9. Lee, C. H. ,Cheng, C. L., Kao, Y. H. Y., Lin, S. J., & Lai, M. L. 2011. Validation Of The National Health Insurance Research Database With Ischemic Stroke Cases In Taiwan. Pharmacoepidemiology And Drug Safety, 20, 236-242.

10.Alatinga, K. A. & Williams, J. J. 2012. Does Membership In Mutual Health Insurance Guarantee Quality Health Care? Some Evidence From Ghana. European Journal Of Business And Social Sciences, 1, 103-118

11. Bassili, A., Dye, C.,Bierrenbach, A., Broekmans, J., Chadha, V., Glaziou, P., Gopi, P., Hosseini, M., Kim, S. & Manissero, D. 2008. Measuring Tuberculosis Burden, Trends, And The Impact Of Control Programmes. The Lancet Infectious Diseases, 8, 233-243.

12. Devadasan, N., Criel, B., Van Damme, W., Lefevre, P., Manoharan, S. & Van Der Stuyft, P.

2011. Community Health Insurance Schemes & Patient Satisfaction-Evidence From India.

The Indian Journal Of Medical Research, 133, 40.

13. D. Adei, V. Osei Kwadwo and S.K. Diko 2012. An Assessment of the Kwabre District Mutual Health Insurance Scheme in Ghana. Current Research Journal of Social Sciences 4(5): 372-382

14. Turkson, P.K. (2009). Perceived Quality of Healthcare Delivery in a Rural District of Ghana.Ghana Medical Journal, 43 (2):65-70

15.Bruce, E., Narh-Bana, S. & Agyepong, I. 2008. Community Satisfaction, Equity In Coverage

And Implications For Sustainability Of The Dangme West Health Insurance Scheme.

Ghana Dutch Collaboration for Health Research And Development.

16. De Allegri, M., Sanon, M. & Sauerborn, R. 2006a. “To Enrol Or Not To Enrol?”: A Qualitative Investigation Of Demand For Health Insurance In Rural West Africa. Social Science & Medicine, 62, 1520-1527


About the Authors

Mavis Aggrey

School of Medical Sciences, Department of Community Health,

Kwame Nkrumah University of Science and Technology Kumasi, Ghana.

Tel: +233 (0)269445677

mavisaggrey@gmail.com
Frank Frimpong Opuni

Marketing Department, Accra Polytechnic School of Business and Management

Accra Ghana

Tel: +233271061481

opunifrank@yahoo.co.uk
Bernard Cudjoe Nkum

Department of Medicine, Komfo Anokye Teaching Hospital

Kumasi, Ghana

Tel: +233209017647



bcnkum@yahoo.co.uk
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

.

GLOBAL CULTURAL PROCESSES IN THE CONTINUITY AND THE PROSPECTIVE OF THE MUSICAL TRADITION


Aida Islam, Stefanija Leshkova Zelenkovska

Abstract
When we mention the word “tradition,” we immediately think of the past. Certainly, the past, in a semantic sense, associates something passed that cannot be returned. However, we are witnessing that in the construction of new and contemporary tradition, we often return to the past and in that way we continuously relive it again. The new achievements are not only the product of adaptation and cultural processes, but they are also new qualitative systems of creative motivations that differ from traditional values. We are considering this study through the prism of the Turkish population in rural settlements, which in certain periods has changed and transformed in its way to modernity as evidenced by today's material and spiritual cultural heritage. They are a reflection of this path, which often passes through contrasts and inevitable contradictions that model the emergence of some new values. In this paper, we traced this complex process from the perspective of the most striking indicators of the spiritual and material musical tradition: musical instruments, performing ensembles, repertoire, and dance. We observed these aspects through the most massive and most abundant ritual ceremonies––weddings that were observed and recorded by field research in the rural settlements of several geographical locations in eastern and western Macedonia. Regardless of the location of settlement, new–modern forms of expression of musical culture are prevailing through the dominance of western provenance instruments, imported repertoire that inevitably entail changes in other ethnological features, as in the costume and during the ritual.
Key words: Cultural Processes, Continuity Musical Tradition, Turkish population, R. of Macedonia.
Citation: Islam, Aida; Zelenkovska , Stefanija Leshkova; Global cultural process in the continuity and prospective of musical tradition; (April, 2014); Journal of Social Sciences (COES&RJ-JSS), Vol.3, No.2, pp: 271-276.

Introduction
We are considering the relation between the tradition and modernity through the prism of the Turkish population in rural settlements in the Republic of Macedonia In certain periods tradition of this ethnicity has changed and transformed in its way to modernity as evidenced by today's material and spiritual cultural heritage. One part of this population consists of Yuruks, a tribe of Turkmen origin inhabiting mostly the mountainous areas of eastern and partly western Macedonia. Due to their compactness and specificity, Yuruks are among the most interesting Turkish groups in the Balkans.
We focused our research of the Yuruk community in eastern and western Macedonia on the current situation in the music traditions–the spiritual and material components of musical cultural heritage, above all, on the musical instruments, performing ensembles and the repertoire. We observed these aspects through the most massive and most abundant ritual ceremonies–weddings that were observed and recorded by field research during the last 5 years in the rural settlements of several geographical locations (eastern Macedonia–Kodzali, Alikoch, Pirnali, Chalikli; western Macedonia–Kodzadzik, Novak, Еlessa, Breshtanic etc.). As additional knowledge, we used videos of two decades old, recordings on which are registered wedding rites with all attributes of the Yuruk tradition. In our field research, we had interviews with informants, mostly members of the older generation, to directly perceive the situation in the musical tradition that is transmitted by oral tradition. We will also use the comparative method to see the causal and consequential influences of socioeconomic and cultural conditioning of the regions that affect today's image of the music culture in this population.
1. The Yörük population in Macedonia
The issue of ethnicity, ethnic consciousness, and ethnic name of Yörüks can hardly be clarified by studying only one scientific field, and this is the main reason that Yörüks are spoken of as a social and not ethnic category.
Yörüks are nomadic tribes that migrated from Anatolia to the territory of Macedonia. We find the oldest records of the presence of Yörüks in the census books (turk. defters) in the Prilep region from 1440, in the Bitola region–1448, Lerin region–1481, where villages are mentioned inhabited by Yörüks. By adapting to the new geographical environment, by changing the nomadic way of life to a settled one, by changing the economic activities, by upgrading the ethnic traits passed from parent area, a Yörük population was formed in Macedonia. Scattered in smaller or larger oases, in different parts, as seminomadic cattlemen or farmers, or as semi-military rows in the Turkish army, through their five centuries of living, Yörüks left traces in the Macedonian toponyms and culture, nurturing their ethnic history through oral tradition. They have preserved their language, which differed significantly from that of the Rumelian Turks and which is very similar to the language of the other Yörük groups in Anatolia. Names of the villages inhabited by Yörüks show that at the time of their settlement they kept the family - tribal organization.
Yörüks exist as specific communities that are characterized by geographical, ethnological, linguistic, and cultural isolation. In the mountainous rural areas that are distant from the urban cores, main roads, infrastructure, and modern social conditions, a greater individuality can be noticed. These features are the result of their long closed social community and delayed provision of some basic benefits of modern living that contributed to maintaining some certain archaic elements.


2. Material cultural tradition
Material culture is conditioned by the level of urban development as confirmed by our field research of some of its elements as architecture, costume, crafts, musical instruments, etc. The houses in which Yörüks live by their program content and architecture reflect the multiple factors that influenced their formation: climate, terrain, materials for construction, material conditionality, etc. Porches and balconies of the houses that were built of crushed stones, mud, and wood, form an integral part of the Yörük houses which have a range of functions in the rural economy. The type of settlements and density of their network were mainly a reflection of the relief features of the terrain, and the size and development of these depended on the socioeconomic conditions of the past and those that prevail today. According to the internal distribution today in most of the settlements, the houses represent a single populated area and very rarely can be seen division into two or three neighborhood (Kodzali with Jukari and Ashagi as two neighborhoods and Dorlomboz with Kuzu Jaka and Orta Jaka Ote Jaka). In the central part of the village, on a broader space, there is a mosque with porch and minaret and fountain built of stone.
Houses that were built during the late 20th century mainly continue the tradition in the spatial organization and in the structures and construction materials used; these are usually buildings with ground and first floor, e.g., of the type of houses "Chardaklija". Today, the urban image of almost all districts is experiencing significant changes with the construction of new, modern houses and paved streets, especially in the villages where the majority of the population constitute migrant workers.
As a part of the material culture, folk costumes of Yörüks in Macedonia have their own features that are preserved to this day and that vary in appearance depending on the region (east and west Macedonia), social status (marital status), and the occasion (daily, ceremonial, and ritual). Generally, these differences are observed in terms of colors, patterns, materials, decorations etc. The feminine dresses are still preserved, the ceremonial and daily ones are ornate with very strong colors and decorations which the Yörük women nurture and develop using some modern materials. We find testimony to the ethnic origin of this social group at the female costumes, which are almost identical to the costumes in some regions of the Republic of Turkey (Kastamonu, Konya, etc.). As far as the male costume is concerned, it can be said that in the recent decades it is almost extinct even from the gathering and ritual events. It is due to their greater communication and adaptation to urban areas due to socioeconomic and sociological conditions (education, employment, etc.).
Handicrafts and weavings among the female population in Yörüks which have always been the expression of the folklore identity are still nurtured almost with the same intensity today. As products of the refined taste, creativity, artistic talent, and manual skills, handicrafts are made for different occasions and different purposes, for example, marriage, clothing and decorations, rugs (bridal, fringed, with pieces, etc.), doilies etc.


3. Musical tradition
Music as an integral part of everyday rural life, in which all major moments of life are accompanied with different customs, is subject to changes as a reflection of the new lifestyle imposed by modernization. It resulted in the disappearance and modification of some types of music repertoire (wedding, labour, lullabies, etc.).
Weddings as largest cultural events contribute to the maintenance of social life and community integration, and they are also indicators of the level of maintenance of tradition. Therefore, in our study, greatest emphasis was placed exactly on these occasions. Accepting elements of the urban lifestyle, especially intensified in recent decades, contributes to changing of the image of spiritual and material cultural values ​​of these traditional ritual ceremonies. In terms of the mentality of the population, such changes (eg. costume–modern clothes, traditional - electronic instruments, reduction of parts of the rituals, etc.) are considered to be modernization, which inevitably means acceptance of the compatible elements, but to some extent it is a fad.
Within the wedding ceremony, the bridal ritual called k'na gedzhesi has a great importance and can be traced as a separate traditional rite as it has its characteristic elements. Carriers of this ceremony are members of the female sex. The music segment, characteristic of this ritual which is expressed through collective vocal singing with rhythmic accompaniment by one or more daires, is slowly disappearing, and is being replaced by musical reproduction of modern technical devices.
The occurrence of changes in these collective manifestations varies from one region to another in Macedonia. It was confirmed by the field research, according to which in western Macedonia wedding music tradition still have more authentic character, unlike the east part where they have adapted to more urban elements.
The wedding ceremonies in villages of eastern Macedonia are accompanied by instrumental ensembles of the western provenance with the dominant use of the synthesizer. In addition to the synthesizer are included saxophone, clarinet, electric guitar, and percussion instruments–drums. Musical ensembles that are engaged are from the surrounding cities, and they are with a different structure of performers, which depends not only on the current engagement of the present musicians but also on the cost of their fee.
By contrast, in the western part of Macedonia are still cherished the traditional instruments, drums and zurlas, which is evident from the observed video materials taken during the wedding. Retention of this segment of the musical tradition is due to the geographical location of these mountain villages with emphasized relief features. But we believe that the determining factor is the occupation of the population (which predominantly constitute the migration workers in Italy), which contributes to the nostalgic preservation of the inherited tradition as a symbol of their identity. In this sense, the wedding ceremonies themselves, which are the fundamental collective gatherings especially during the summer, still contain authentic music expression, which confirm their rich tradition.
The music repertoire that is present during the weddings can be divided into traditional and modern. In the first group is present the repertoire in which traditional folk and Rumelian songs of the wider region prevail, while in the second group, the repertoire is dominated by the newly created folk music from the Republic of Turkey.
The traditional repertoire prevails in a small number of rural areas, mainly in western Macedonia where music tradition is still manifested within the inherited tradition. The modern repertoire prevail in east Macedonia, where the choice of music is dictated by the engaged instrumental ensemble, which contributes to the dominant presence of the new folk trend.
Conclusion
From the analysis, it can be concluded that the musical tradition of the Yörüks population in Macedonia experiences modifications as a reflection of modern musical trends. That is, technical and technological innovations result in changes in musical instruments, where the traditional instruments have ceded their positions to the modern import instruments, with the dominance of the synthesizer. The reduction in the presence of traditional musical repertoire and dominance of global influences are significant, especially among the younger population, as a result of the acceptance of the novelties of modern urban living.
References
Bose, Fritz (1975) Ethnomusicologija, Univerzitet umetnosti, Beograd.

Bowie, Fiona (2006) The Antropolgy of Religion, Blackwell Publishing Limited.

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About the Authors:
Ph.D. Prof. Aida Islam graduated at the Faculty of Music Art in Skopje. 2002 finishes the M. A. degree in the area of Theory of Interpretation. She received her Ph.D. in 2005. Since 2001 she works as a professor at the Faculty of Padagogy “St. Climent Ohridski” in Skopje on subjects Methodic of Music education, Basics of Music Education and Musical Instruments.
Ph.D. Prof. Stefanija Leshkova Zelenkovska graduated at the Faculty of Music Art in Skopje - Musicology Department. 2002 finishes the M. A. degree in the area of Musicology. She received her Ph.D. in 2006. Since 2007 she works as a professor at the Faculty of Music Art in Shtip on subjects History of Music, History of Macedonian music, Musical Instruments and Aesthetic of Music .

THEORY OF SEGMENTED ASSIMILATION:

A COMPARATIVE STUDY OF NIGERIAN MIGRANTS’ INTEGRATION IN KWAZULU NATAL PROVINCE
Prof Shanta B Singh, Kombi Sausi, Prof Modimowabarwa Kanyane


Abstract:

This article applies the framework of segmented assimilation which analyzes different patterns of migrant integration to understand variations in transnational activities among Nigerian migrants in Durban. It examines the role of migrant integration in determining the types of cross-border activities migrants pursue and their level of engagement in these activities. Given the monetary and legal resources needed to facilitate certain transnational activities, the article reveals that migrants with greater social and economic mobility in the host country demonstrate a wider range and an increased frequency of transnational behaviours. For instance, Nigerian migrants having legal migration status and occupational mobility demonstrate greater transnational behaviours than those illegally residing in South Africa and employed in low-wage menial jobs. It further, examines how South Africa’s migration policies and the social context of reception affect the integration of migrants in their transnational activities.
Keywords:

Segmented assimilation, Nigerian migrants, transnational activities, South Africa’s migration policies.


Citation:

Prof Shanta B Singh, Kombi Sausi, Prof Modimowabarwa Kanyane; Theory of segmented assimilation: A comparative study of Nigerian migrants’ integration in Kwazulu Natal Province; (January, 2014); Journal of Social Sciences (COES&RJ-JSS), Vol.3, No.1, pp: 224-233.



Introduction
The article examines how the social and economic integration of Nigerian migrants in KwaZulu- Natal Province affect their participation in transnational activities, or behaviours that enable them to maintain social ties in their countries of origin. With the emergence of transnational migration studies, the focus of international migration research has largely shifted from examining migrant integration in receiving nations to exploring their transnational behaviours. However, the relationship between migrant integration in the receiving country and the types of transnational activities migrants pursue, as well as the degree of their involvement in these activities has not been directly studied. Some migration scholars have suggested that transnationalism is, in part, an adaptive strategy, a reaction to the hostile reception and downward mobility that non-white migrants face in post-industrial nations (Basch et al. 1994; Portes 1997, 1999; Waters 1999; Faist 2000). Given the monetary and legal resources needed to facilitate certain transnational activities, downward mobility in the receiving society appears to limit the capacity of migrants to engage in these behaviours. The critical question of how Nigerian migrant integration affects transnational behaviour remains unanswered. The article addresses this issue by exploring how participation in transnational behaviours varies across the different patterns of migrant adaptation as outlined by the framework of segmented assimilation (Portes and Zhou 1993; Zhou 1997).
Segmented assimilation explains the individual and contextual factors that account for the different patterns of migrant integration (Zhou 1997). If the extent to which migrants participate in transnational behaviours depends on the resources available to them, then the transnational activities of migrants with increasing social and economic mobility in the host country is greater in range and frequency. Conversely, the transnational activities of Nigerian migrants with declining mobility are more constricted (Portes 1999; Levitt 2000; Kivisto 2001). Therefore, the article shows that Nigerian migrants with legal immigration status and occupational mobility demonstrate greater transnational behaviours than those illegally residing in South Africa and employed in low-wage labour.
Methodological issues
Based on the research question posed: , how does the social and economic integration of Nigerian migrants affect the types of transnational activities they pursue and the degree of their involvement in these activities, the hypothesis migrants with greater social and economic integration in the host country demonstrate a wider range and an increased frequency of transnational behaviours emerges. This question contains four variables to be measured:

a) The level of incorporation of Nigerian migrants in South Africa’s economy;

b) The level of their social adaptation;

c) The types of transnational activities they practice; and



d) The frequency of engagement in these activities.
This article is based on data collected and observation made in 2008-2009 in Durban central business district (CBD) of the KwaZulu-Natal Province. The city’s diversified economy offers opportunities in both the primary and secondary sectors for migrants. An underground economy involving traffic in drugs, sex and stolen goods, in which Nigerian migrants are allegedly engaged coexists with the legitimate economic activities. With the availability of these opportunities, it is not surprising that Durban has one of the largest numbers of African migrants in South Africa. It is for this reason that a high concentration of Nigerian migrants made the city an appropriate field site for this study.
Conceptual and theoretical issues
Basch et al. (1994:7) define transnationalism as the practices that enable migrants to maintain multiple social relations across national boundaries, binding migrants in countries of settlement and non-migrants in countries of origin. These social relations range from individual to collective ties including familial, economic, organizational, political and religious connections (Basch et al. 1994). With regards to the relationship between transnationalism and migrant integration, some researchers of migration studies have interpreted the transnational activities of recent nonwhite migrants as partly a response to the negative reception and marginal status faced in the United States (Portes 1997, 1999; Portes et al. 1999; Waters 1999; Faist 2000). Waters (1999:16) observes that for West Indian migrants in New York City, assimilation means becoming black American, a “stigmatized” minority; whereas a transnational identity, one that transcends nation-states, enables them to circumvent the racial categorization of the United States. However, while transnationalism may be partially a response to downward mobility or negative reception in the host society, income from low-wage menial jobs does not provide the monetary resources needed to facilitate certain transnational activities. Moreover, discriminatory immigration policies deny targeted groups the necessary legal rights to cross national borders.
Offering a different interpretation to the relationship between transnational behaviour and migrant integration, Kivisto (2001:557) defines transnationalism as a form of assimilation on the basis that migrants maintain social ties in their countries of origin while engaging in processes of acculturation in the host society. Moreover, Kivisto further argues that contrary to the transnational view of migrants simultaneously living in two countries, at any given moment migrants are located in one, and the immediate concerns of the receiving country take precedence over the more distant concerns of the sending community. However, understanding transnationalism as a form of assimilation or adaptation does not take into account the variation of transnational behaviours among migrants with comparable familial and social ties in their countries of origin. Why do some migrants travel back and forth while others simply send remittances? This article shows that the socio-economic integration of migrants in the host society accounts for much of the variance in transnational behaviour.
The theory of segmented assimilation offers a framework for understanding the relationship between transnational behaviour and migrant integration. Segmented assimilation attempts to explain the individual and contextual factors that determine into which segments of the host society second-generation migrants become incorporated (Zhou 1997:983). Three distinct outcomes of migrant adaptation are possible and these are (a) upward mobility through conventional acculturation and economic integration into the middle class; (b) positive perception as a result of economic integration into the middle class while retaining the migrant group’s values and affiliation and lastly downward mobility due to acculturation and economic integration into the underclass (Portes and Zhou 1993:85; Zhou 1997:1002). It is now clear that segmented assimilation differs from classical assimilation and multicultural paradigms in its consideration of downward mobility (Portes and Zhou 1993; Zhou 1997).
Although segmented assimilation has been used to describe the possible outcomes of second-generation adaptation with modifications, these outcomes are applicable to the first generation. For example, first-generation migrants can suffer downward mobility as a result of their economic incorporation into low-wage employment while experiencing minimal acculturation. Three features of the receiving environment that contribute to downward mobility: discrimination, residence in impoverished areas, and restricted economic opportunities are identified. The environment in which Nigerian migrants find themselves in South Africa presents all of these features. The limited acceptability of African migrants in South African society, their economic incorporation into the secondary sector, and the clandestine nature of their migration set conditions for the creation of a migrant underclass (Portes and Zhou, 1993:91).
An alternative to less desirable work in the secondary sector is the ethnic labour market. Portes and Zhou (1992) observe that Dominican, Cuban, and Chinese migrants, who remain within the ethnic economy, particularly entrepreneurs, do better than those who are not part of an ethnic economy. Resources made available through ethnic networks and niches enable migrants to avoid downward mobility (Portes and Zhou 1992, 1993). With the possible trajectories of migrant adaptation mainstream, underclass, and ethnic enclave the question of how transnational behaviour varies across the different patterns of adaptation becomes critical. To answer this question we used the variable below to measure the social, economic and cultural integration of Nigerian migrants in Durban.
Variable to Measure Nigerian migrants’ Integration
Occupational, immigration, income and educational levels amongst others are critical measures employed to measure Nigerian migrants in Durban.


  • Occupational status in South Africa

Because dual labour market theory (Piore, 1979:110) has been the foremost perspective for understanding the economic incorporation of migrants in industrial countries, employment in the primary and secondary sectors are indicators of integration with the former having more weight than the latter. Self-employment, described as an alternative to less desirable work in the secondary sector (Portes and Zhou 1992:507), have a higher score than work in the secondary sector, but is less than employment in the primary sector since entrepreneurship is usually within the ethnic enclave. Occupation has been shown to be the best single predictor of social status and educational attainment and income are correlated with occupation (Miller and Salkind 2002).




Occupation in South Africa


The occupations of migrants is a topic that was covered extensively during interviews and reflected a high mobility within certain segments of the labour market, specifically saloons, cell phone and computer shops and clothing shops which are male dominated. At the time of the interviews three worked in the tuck shop with 1 male and 2 female. One male worked as a shop assistant and 2 males owned a sports bar and 2 others owned taverns. Two women were hair dressers and one owned a saloon. All migrants had changed employment multiple times and sometimes had switched between several sectors. A majority of the Nigerian migrants started working in saloons as hairdresser and ended up becoming self employed. Men ended up owning cell phone shops, computer shops and clothing shops because they find them more lucrative than other type of economic activities available to migrants in Durban. One of the participants from Ijo in the Delta region mentioned that many Nigerians he knew sought out flee market vending and moved to different markets within KwaZulu-Natal and the Eastern Cape Provinces. He had done it himself but could not continue because the income from the business was very low. He was a primary school teacher before migrating to Durban but his wife and son are in Nigeria.


  • Immigration status

Legal status is an essential variable in the process of integration (Massey et al. 1987:1502). Legal status offers economic and social welfare opportunities unavailable to undocumented migrants that encourage integration. Powers et al. (1998:75) found that Mexican migrants in the United States experienced upward mobility from the first jobs they held after legalizing their status. Moreover, residency and citizenship give rights that facilitate particular transnational behaviours. For example, the legalization of status in the host country permits movement between sending and receiving countries without punitive consequences, which increase travel between the two countries. Because Nigerian immigration to South Africa is largely clandestine, many have legalized their immigration status by seeking asylum.



  • Income level per annum




The income level figures for the participants were based on their own estimates of their net weekly or monthly earning, so the results were approximate amounts, but the income level of the fifty participants was divided into six categories. Fourteen participants earn between R40 000 to R59 000 per annum. However, in the interviews conducted, those earning less than R40 000 per annum described their economic situation as unsatisfactory or tight and only eight participants were satisfied with their economic situation. Migrants describe their work schedule as strenuous, having to work six or seven days a week and not being able to take vacations or not willing to do so because it could mean losing customers. Of the two individuals who did not provide any income information, one was unemployed and the other was a woman who could not provide information on her family’s annual income.

  • Education level



The table shows that all participants have primary education. 20 males attended secondary school and 3 female also completed secondary education. 7 males started tertiary education but did not complete their studies due to financial difficulties and leaving Nigeria to pursue their life in South Africa- hoping that they will return to school once they can afford to finance their studies. 9 females went to university but did not complete their university education due to marriage as well as financial constraints. Only 8 were able to migrate with an undergraduate degree and 3 hold post graduate degrees, 2 of whom hold an honors degree and 1 a masters degree. Looking at these figures; 23 of the 50 participants have a high school certificate.

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